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This study aimed to form astute deductions regarding the presentation, treatment and mortality of otogenic brain complications.
Methods
A systematic literature search of four medical databases (PubMed, Embase, Web of Science and Scopus) was conducted. Studies associated with otogenic brain complications were considered eligible. Fixed- and random-effects model meta-analysis was developed to assess the proportion estimate for each outcome individually.
Results
Twenty-eight studies, with 1650 patients in total, were included. In 66 per cent of patients there was a known history of chronic otitis media. The most common symptoms were purulent otorrhoea (84 per cent), headache (65 per cent) and otalgia (45 per cent). A brain abscess was observed in 49 per cent of patients, followed by meningitis (34 per cent) and sinus thrombosis (22 per cent). A combination of surgical and conservative therapy was chosen in 84.3 per cent of cases and the mortality rate approached 11.1 per cent.
Conclusion
Otogenic brain complications are a possibly life-threatening condition. Prompt imaging examination may set the final diagnosis and lead to an effective treatment.
To determine the validity of parent reports (PRs) of ADHD in preschoolers, we assessed hyperactivity/impulsivity (HI) and inattention (IN) in 1114 twins with PRs at 1.5, 2.5, 4, 5, 14, 15, and 17 years, and teacher-reports at 6, 7, 9, 10, and 12. We examined if preschool PRs (1) predict high HI/IN trajectories, and (2) capture genetic contributions to HI/IN into adolescence. Group-based trajectory analyses identified three 6–17 years trajectories for both HI and IN, including small groups with high HI (N = 88, 10.4%, 77% boys) and IN (N = 158, 17.3%, 75% boys). Controlling for sex, each unit of HI PRs starting at 1.5 years and at 4 years for IN, increased more than 2-fold the risk of belonging to the high trajectory, with incremental contributions (Odds Ratios = 2.5–4.5) at subsequent ages. Quantitative genetic analyses showed that genetic contributions underlying preschool PRs accounted for up to a quarter and a third of the heritability of later HI and IN, respectively. Genes underlying 1.5-year HI and 4-year IN contributed to 6 of 8 later HI and IN time-points and largely explained the corresponding phenotypic correlations. Results provide phenotypic and genetic evidence that preschool parent reports of HI and IN are valid means to predict developmental risk of ADHD.
We examined the influences of slip parameters on the velocity and thermal characteristics of a ferrofluid film of fixed thickness. The flow is generated on a rough and inclined whirling surface that is positioned in an external magnetic (dipole) field. The similarity transformation reduces the model equations (continuity, momentum, energy and concentration), and the solution of the normalized coupled ordinary differential equations is carried out through the finite element process. The influences of slip effects, Brownian motion, thermophoresis and a heat source on the velocity (radial, tangential and axial), gravity (drainage, induced), temperature profile and concentration profile are determined. The tangential flow and temperature are both decreased by an increase in the velocity slip parameter, whereas drainage, induced, radial and axial flows are increased. Enlarging the thermal slip parameter decreases the temperature. Improving slip parameters (velocity and thermal) also improves the concentration profile. Both Nusselt and Sherwood numbers are found to improve on improving the velocity slip parameter, while they decrease on decreasing the thermal slip parameter. The results and insights from this work could be applied to a wide range of medicinal fields, such as targeted medication therapy and delivery, tissue engineering, etc. as well as different industrial processes including coating, lubrication, heat transfer, etc.
Pulmonary atresia with ventricular septal defect, non-confluent pulmonary arteries, and bilateral arterial duct is a rare and complex CHD. Physiologic ductal closure may lead to life-threatening hypoxia. We present a case of successful bilateral ductal stenting as a bridge to further lower-risk surgical repair.
Although anti-racist adaptations to dialectical behaviour therapy (DBT) are emerging, little qualitative research exists exploring adolescents’ perspectives on therapists’ approach, cultural competency and humility regarding ethnicity, race and culture (ERC) within DBT. This study explored diverse adolescents’ experiences of talking about ERC during all aspects of DBT treatment. Ten adolescents from diverse ERC backgrounds who attended DBT at a National and Specialist Child and Adolescent Mental Health Service (UK) completed semi-structured individual interviews that were transcribed verbatim and analysed using reflexive thematic analysis, adopting a critical realist approach. Five over-arching themes were developed from the data. Theme 1 captures the power for explicit ERC-related conversations to facilitate change, as they are frequently overlooked in therapy. Theme 2 discusses factors that facilitate or inhibit ERC-related discussions. Theme 3 captures the difficult ‘double bind’ that adolescents find themselves in: not wanting to be a spokesperson for ERC issues whilst hoping for their therapist to facilitate/model ERC-related discussions. Theme 4 explores how adolescents navigated their identity in relation to ERC, their wider systemic context, and experiences of ERC-related trauma. Theme 5 explored therapeutic alliance, and how therapists might encourage DBT skills use with greater ERC sensitivity, emphasising validation. Using a bottom-up approach, we show a clear mandate from diverse adolescents for (White) clinicians to proactively create the space and safety required for ERC-related discussions. We emphasise the importance of anti-racist praxis including cultural humility, multi-cultural competencies, and validation of ERC-related difficult experiences within a wider systemic context.
Key learning aims
(1) A recent publication by Pierson et al. (2022) has raised the importance for White DBT therapists to adopt an anti-racist position and actively reflect on how a lack of anti-racist stance can form therapist treatment-interfering behaviours.
(2) The current study explores the views of adolescents from diverse ethnic, racial and cultural (ERC) backgrounds on how ERC issues are being brought into DBT.
(3) Adopting a bottom-up approach, we identify key themes from adolescents’ perspectives on the barriers and facilitators to talking about ERC in the therapy room, why such discussions are important in supporting adolescents to navigate their own identity in therapy, and recommendations for clinicians to consider on ways of increasing and enhancing such conversations in the clinical setting.
A eulimid gastropod of the genus Ophieulima, parasitic on the disc of the ophiactid brittle star Ophiactis dyscrita, was collected from 256–343 m deep off Kanagawa, central Japan. This represents the first record of the genus from Japanese waters and even from the North Pacific Ocean. Here we describe it as Ophieulima yoshiharai n. sp. The generic assignment is justified by its conchological characters including (1) a small, conical shape with convex teleoconch whorls, (2) many fine growth lines and some strong growth pause scars on the teleoconch, (3) a well-developed, twisted columella, and (4) a multispiral, brownish transparent protoconch. Ophieulima yoshiharai n. sp. is distinguishable from the three (two named and one undescribed) extant, as well as two fossil congeners by its slender shell with the length of 2.1 times larger than width, a small aperture and a protoconch of 3.5 whorls. The new species is also characterized by its bathymetric distribution, which is shallower than the extant species of Ophieulima. On the other hand, the hosts of Ophieulima species are so far restricted to ophiuroids of the genus Ophiactis and the three named species have mostly been found attached to the lateral and/or dorsal sides of the host's disc, suggesting their similar parasitic ecology.
Sickness insurance companies were developed in Spain by doctors and healthcare professionals, remaining outside the interests of general insurance companies. Their management was hardly professional, with limited actuarial techniques and they only accounted for a small percentage of total insurance business premiums. From the 1970s onwards, various factors changed this situation, driving processes of concentration, with numerous takeovers and mergers, first reducing the number of local and regional companies to the benefit of companies of national scope. Subsequently, the growth in demand for this type of coverage sparked the interest of national general insurance companies and multinationals, leading to a restructuring of the sector which has progressively acquired greater weight within the insurance business and become increasingly internationalised. This last stage immersed the health sector in Spain in the great processes of globalisation of the sector, characterised by a financialisation of capital promoted by the bank investment funds. These processes are little known and are the focus of analysis of this paper, with the aim of enabling comparison at international level.
This multi-method longitudinal study sought to investigate linkage in parental neuroendocrine functioning – indicated by cortisol – over two measurement occasions. In addition, we examined how parental cortisol linkage may operate as an intermediate factor in the cascade of contextual risks and parenting. Participants were 235 families with a young child (Mage = 33.56, 36.00 years for mothers and fathers respectively), who were followed for two annual measurement occasions. Parental cortisol linkage was measured around a laboratory conflict discussion task at both measurement occasions (i.e., pre-discussion, 20- and 40-minute post-discussion for each measurement occasion). Maternal and paternal parenting behavior was observed during a parent-child discipline discussion task. Findings indicated similar levels of cortisol linkage between parents over the two measurement occasions. Furthermore, cortisol linkage between parents operated as an intermediate factor between contextual risks and more compromised parenting behavior. That is, greater contextual risks, indicated by greater neighborhood risk and interparental conflict, were linked to greater cortisol linkage between parents over time, which was in turn linked to greater authoritarian parenting during parent-child interaction. Findings highlighted the importance of understanding physiological-linkage processes with respect to the impact of contextual risks on family functioning and may have crucial implications for clinical work.
Continuum robot has become a research hotspot due to its excellent dexterity, flexibility and applicability to constrained environments. However, the effective, secure and accurate path planning for the continuum robot remains a challenging issue, for that it is difficult to choose a suitable inverse kinematics solution due to its redundancy in the confined environment. This paper presents a collision-free path planning method based on the improved artificial potential field (APF) for the cable-driven continuum robot, in which the beetle antennae search algorithm is adopted to deal with the optimal problem of APF without the necessary for velocity kinematics. In addition, the local optimum problem of traditional APF is solved by the randomness of the antennae’s direction vector which can make the algorithm easily jump out of local minima. The simulation and experimental results verify the efficiency of the proposed path planning method.
We show that for every finite set of prime numbers $S$, there are at most finitely many singular moduli that are $S$-units. The key new ingredient is that for every prime number $p$, singular moduli are $p$-adically disperse. We prove analogous results for the Weber modular functions, the $\lambda$-invariants and the McKay–Thompson series associated with the elements of the monster group. Finally, we also obtain that a modular function that specializes to infinitely many algebraic units at quadratic imaginary numbers must be a weak modular unit.
We prove the Hasse principle for a smooth projective variety $X\subset \mathbb {P}^{n-1}_\mathbb {Q}$ defined by a system of two cubic forms $F,G$ as long as $n\geq 39$. The main tool here is the development of a version of Kloosterman refinement for a smooth system of equations defined over $\mathbb {Q}$.
Tao and Vu showed that every centrally symmetric convex progression $C\subset \mathbb{Z}^d$ is contained in a generalized arithmetic progression of size $d^{O(d^2)} \# C$. Berg and Henk improved the size bound to $d^{O(d\log d)} \# C$. We obtain the bound $d^{O(d)} \# C$, which is sharp up to the implied constant and is of the same form as the bound in the continuous setting given by John’s theorem.
Morphological symmetry abnormalities in cheliped appendages of alpheid shrimps are extremely rare and poorly recorded in the literature. A symmetric minor cheliped were, for example, observed in queen females belonging to Synalpheus eusocial species. Symmetric major chelipeds were now described in Synalpheus fritzmuelleri individuals living in shallow Brazilian waters. These individuals were found in symbiotic association with the bryozoan Schizoporella sp. (biogenic substrate) adhering to the pilings of Ubatuba Bay docks, São Paulo State. Only one of 20 sampled S. fritzmuelleri individuals presented anomalous symmetric chelipeds. Based on carapace length, size, and morphological features, the analyzed specimens seemed to be juvenile; thus, the hypothesis of anomalous condition can be directly linked to genetic inhibition of the mechanism accounting for major cheliped development in this ontogeny phase. Studies like the present one often provide remarkable information on animal morphology and can be used as reference in evolutionary assessments to be conducted in the future.
There is limited data on the organisation of paediatric echocardiography laboratories in Europe.
Methods:
A structured and approved questionnaire was circulated across all 95 Association for European Paediatric and Congenital Cardiology affiliated centres. The aims were to evaluate: (1) facilities in paediatric echocardiography laboratories across Europe, (2) accredited laboratories, (3) medical/paramedical staff employed, (4) time for echocardiographic studies and reporting, and (5) training, teaching, quality improvement, and research programs.
Results:
Respondents from forty-three centres (45%) in 22 countries completed the survey. Thirty-six centres (84%) have a dedicated paediatric echocardiography laboratory, only five (12%) of which reported they were European Association of Cardiovascular Imaging accredited. The median number of echocardiography rooms was three (range 1–12), and echocardiography machines was four (range 1–12). Only half of all the centres have dedicated imaging physiologists and/or nursing staff, while the majority (79%) have specialist imaging cardiologist(s). The median (range) duration of time for a new examination was 45 (20–60) minutes, and for repeat examination was 20 (5–30) minutes. More than half of respondents (58%) have dedicated time for reporting. An organised training program was present in most centres (78%), 44% undertake quality assurance, and 79% perform research. Guidelines for performing echocardiography were available in 32 centres (74%).
Conclusion:
Facilities, staffing levels, study times, standards in teaching/training, and quality assurance vary widely across paediatric echocardiography laboratories in Europe. Greater support and investment to facilitate improvements in staffing levels, equipment, and governance would potentially improve European paediatric echocardiography laboratories.
Two species of deep-sea skates, Amblyraja frerichsi and Notoraja martinezi, are reported for the first time in Peruvian waters, representing the first record of their respective genera from the country. Earlier, A. frerichsi was known from both the southwestern Atlantic (off Brazil, Uruguay, and Argentina) and southeastern Pacific (off Chile), while N. martinezi was known from Costa Rica to Ecuador in the eastern-central and southeastern Pacific. This study contributes to the limited knowledge of deep-sea fish diversity along the South American west coast, and stresses the need of further taxonomic research in the region, particularly in light of the ecological importance of this group of fishes in marine ecosystems and its conservation state worldwide.
Luidia iwakiensis n. sp. (Asteroidea, Echinodermata) is described in Japanese waters. A molecular phylogenetic analysis including 18 Luidia species supported Döderlein L (1920, Siboga Expedition 4, 193–291) four morphogroups. Morphological reconsideration revealed three of the eight criteria of the morphogroup adopted by Döderlein were justified, but the remaining five characters were rejected. The placement of the new species in the Ciliaris-group was supported by molecular as well as morphological evidence, however, it varies from other species of Ciliaris-group by arm number, length of major inferomarginal spines, and pedicellariae on actinal plates.
Mediterranean climate regions (hereafter ‘Med-regions’) cover small areas globally but harbour a wide diversity of ecosystems that are under serious threat due to current global climate change. Despite intensive research and conservation efforts in freshwater, marine and terrestrial ecosystems to prevent the consequences of habitat fragmentation, overfishing and changes in fire regimes and heatwaves, there is still no global consensus on how to conserve and manage Med-region ecosystems. We define integrative research as an interdisciplinary approach with common concepts and metrics enabling a better understanding of the general mechanisms underlying ecosystems. Building upon existing literature that promotes integrative research in Med-region ecosystems, we advocate for a more integrative approach that takes into consideration cross-ecosystem generalities and common resilience mechanisms. We propose examples of potential studies for implementing such integrative research, including: (1) integrative research across ecosystems; (2) integrative research across Med-regions; and (3) integrative research across political boundaries. We then offer recommendations for promoting integrative studies, including leveraging biodiversity data, establishing working groups in research syntheses and testing theoretical frameworks. Promoting integrative research in Med-regions would enable and facilitate the roadmap towards a better understanding of Med-region ecosystems’ responses to natural and anthropogenic disturbances and the identification of ecological baselines. We seek to foster future research synergies to identify tipping points across ecosystems and aid in determining desired future conditions in Med-regions globally.
Augmented Depression Therapy (ADepT) is a novel wellbeing and recovery-oriented psychological treatment for depression. A recent pilot trial run in a university clinic setting suggests ADepT has potential to be superior to cognitive behavioural therapy (CBT) at treating anhedonic depression in a NHS Talking Therapies for anxiety and depression (NHS–TTad) context. Before proceeding to definitive trial in pragmatic settings, it is important to establish if therapists in routine NHS-TTad settings can be trained to deliver ADepT effectively and to assess therapist views on the feasibility and acceptability of ADepT in this context. A bespoke training and supervision pathway was developed (2-day workshop, four 2–hour skills classes, and 6 months of weekly supervision) and piloted with 11 experienced therapists working in a single NHS–TT service in Devon. Nine out of 11 therapists completed the placement, treating 24 clients with a primary presenting problem of depression; 21/24 completed a minimum adequate dose of therapy (≥8 sessions), with 17/24 (71%) showing reliable improvement and 12/24 (50%) exhibiting reliable recovery. Eight out of nine therapists submitted a session for competency assessment, all of whom were rated as competent. Nine therapists submitted feedback on their experiences of training. Eight out of nine therapists felt the ADepT model would be effective in an NHS–TTad context; that training was interesting, useful, well presented and enhanced their own wellbeing; and that they felt sufficiently skilled in core ADepT competencies at the end of the placement. This suggests that NHS–TTad therapists can be trained to deliver ADepT competently and view the treatment as feasible and acceptable.
Key learning aims
(1) To become familiar with the Augmented Depression Therapy (ADepT) approach for enhancing wellbeing in depression.
(2) To evaluate the potential utility and feasibility of ADepT model in NHS Talking Therapies Services (NHS–TTad).
(3) To understand the pilot ADepT training and supervision pathway for CBT therapists in NHS–TTad services.
(4) To consider the opportunities and challenges of training therapists to deliver ADepT in NHS–TTad services.